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SCOTT BARKOWSKI
John E. Walker Department of Economics Clemson University
Faculty Scholar School of Health Research Clemson University
Fields of research interest
- Health economics
- Labor economics
- Econometrics
- Industrial Organization
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Working Papers
Young Children and Parents' Labor Supply during COVID-19 ABSTRACT: We study the COVID-19 pandemic’s effects on the labor supply of parents with young children. Using the monthly Current Population Survey, and following a pre-analysis plan, we use three difference-in-differences variations to compare workers with childcare needs to those without. The first compares parents with young children and those without young children, while the second and third rely on the presence of someone who could provide childcare in the house: a teenager in the second and a grandparent in the third. We analyze three outcomes: whether parents were “at work” (not sick, on vacation, or otherwise away from his or her job); whether they were employed; and hours worked. Contrary to expectation, we find the labor supply of parents with young children was not negatively affected by the COVID-19 pandemic. Instead, some evidence suggests parents with young children were more likely to be working after the pandemic unfolded. Moreover, our results are not systematically different for men and women. This suggests that other factors like employer adjustments to allow employees to work at home and the availability of informal sources of childcare allowed parents to avoid major shocks to their labor supply during the pandemic.
Physician Response to Prices of Other Physicians: Evidence from a Field Experiment
- Contact me for early draft
ABSTRACT: I examine the importance of cost information in the physician referral process. I partner with a group of physician medical practices -- an Independent Practice Association ("IPA'') -- to perform a field experiment testing whether providing information on the costliness of specialist physicians to primary care physicians (PCPs) alters the PCPs' referral behavior. The IPA's primary care practices were assigned randomly to treatment or control groups, and the treatment group practices were provided a list of average costs for several ophthalmologists that are affiliated with the IPA. Using data collected by the IPA, I compare differences in referral rates to the ophthalmologists of interest between the treatment and control groups. My results suggest that, during the first two months following the distribution of the cost list, the treatment group PCPs reallocated referrals towards the least expensive ophthalmology practice by 112% when the patients were the type where the costs incurred by the IPA for the referral depend on the treatment choices of the specialist. This large effect dissipated significantly, though not completely, over the following four months. For patients where specialist treatment choices have little impact on the costs the IPA incurs for referrals, I find no response to the treatment. This contrast in results suggests that PCP responses were influenced by cost reduction motives.
Published / Forthcoming Articles
Does Government Health Insurance Reduce Job Lock and Job Push?
ABSTRACT: I study job lock and job push, twin phenomena believed to be partially due to employment-contingent health insurance (ECHI). Using variation in Medicaid eligibility among household members of male workers to identify changes in those workers’ reliance on ECHI, I estimate notable job lock and job push effects. For married male workers, a 15 percentage point increase in the likelihood a household member is eligible for Medicaid increases the rate of voluntary job exits over a four-month period by 14 percent. For job push, the same increase in a household member’s likelihood of Medicaid eligibility reduces the transition rate into jobs with ECHI among all male workers by 8 percent.
In
Sickness and in Health: Interaction Effects of State and Federal Health
Insurance Coverage Mandates on Marriage of Young Adults
ABSTRACT: We
study the interaction of state and federal dependent health insurance
mandates on young adult marriages. Using a new dataset on state-level
mandates, we show marriage restrictions of these laws reduced marriage
likelihoods by about two percentage points. When the Affordable Care Act
(ACA) was enacted, its mandate ended marriage restrictions, encouraging
marriage among those previously eligible for state mandates. However,
among those ineligible for state mandates, it discouraged marrying to
obtain insurance through spouses. The combination of these contrasting
ACA effects eliminated the marriage gap. We also find these marriage
effects resulted in corresponding impacts on out-of-wedlock births.
A Reevaluation of the Effects of State and ACA Dependent Coverage Mandates on Health Insurance Coverage
ABSTRACT: We
study state and federal health insurance coverage mandates for young
adults. Despite consistent findings that the Affordable Care Act's (ACA)
federal mandate was effective, research has disagreed on whether
pre-existing, state-level mandates were successful in increasing
coverage. We reconsider the issue with a new analytical perspective and
newly available, accurate data on state mandates. We show that the
impact of the state mandates was substantive and concentrated among
young adults between ages 19 and 23. Our estimates indicate that the
dependent coverage rose by 3.9 percentage points and overall coverage
rose by 3.3 percentage points. Crowd out of coverage through young
adults' own jobs was negligible. For those above 23, we find little
evidence of changes in coverage. We incorporate these insights into
analysis of the ACA's mandate, showing its effects were focused among
those who were not eligible for state mandates, or were eligible but
older than 23. Our results suggest eligibility restrictions played
important roles in limiting the scope of the state mandates, but they
can be practical and effective tools for policymakers looking to ensure
or expand coverage for young adults in the face of uncertainty about the
ACA.
The Effect of Health Insurance on Crime: Evidence from the Affordable Care Act Medicaid Expansion
ABSTRACT: Little
evidence exists on the effect of the Affordable Care Act (ACA) on
criminal behavior, a gap in the literature that this paper seeks to
address. Using a simple model, we argue we should anticipate a decrease
in time devoted to criminal activities in response to the expansion,
since the availability of the ACA Medicaid coverage raises the
opportunity cost of crime. This prediction is particularly relevant for
the ACA expansion since it primarily affects childless adults, a
population likely to contain individuals who engage in criminal
behavior. We validate this forecast empirically using a
difference-in-differences framework, estimating the expansion's effects
on panel datasets of state- and county-level crime rates. Our estimates
suggest that the ACA Medicaid expansion was negatively associated with
burglary, vehicle theft, homicide, robbery, and assault. These
crime-reduction spillover effects represent an important offset to the
government's cost burden for the ACA Medicaid expansion.
Does Regulation of Physicians Reduce Health Care Spending?
ABSTRACT: The medical community argues that physician fear of legal liability increases health care spending. Theoretically, though, the effect could be positive or negative, and empirical evidence has supported both cases. Previous studies, however, have ignored the fact that physicians face risk from industry oversight groups like state-level medical licensing boards in addition to civil litigation risk. This paper addresses this omission by incorporating previously unused data on punishments by oversight groups against physicians, known as adverse actions, along with malpractice payments data to study state-level health care spending. My analysis suggests that, contrary to conventional wisdom, spending does not rise in response to increased risk. An increase in adverse actions of 16 (the year-to-year average) is associated with statistically significant, annual decreases in state spending on hospital care of approximately $22 million, and on prescription drugs of nearly $10 million. Malpractice payments are estimated to have smaller, statistically insignificant effects.
ABSTRACT: Employment-contingent
health insurance may create incentives for ill workers to remain
employed at a sufficient level (usually full-time) to maintain access to
health insurance coverage. We study employed married women, comparing
the labor supply responses to new breast cancer diagnoses of women
dependent on their own employment for health insurance with the
responses of women who are less dependent on their own employment for
health insurance, because of actual or potential access to health
insurance through their spouse’s employer. We find evidence that women
who depend on their own job for health insurance reduce their labor
supply by less after a diagnosis of breast cancer. In the estimates that
best control for unobservables associated with health insurance status,
the hours reduction for women who continue to work is 8 to 11 percent
smaller. Women’s subjective responses to questions about working more to
maintain health insurance are consistent with the conclusions from
observed behavior.
Economics Conference Bingo ABSTRACT: We describe a bingo-style game intended to be played at economics conferences. Early results from implementation of the game by economists at conferences suggest that fun increases more than a full standard deviation. Further study of the effects of the game is ongoing.
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